Adult’s Transition Decision Portrayed as Scandal by Anti-Trans Right
In New Jersey, an 18-year-old trans woman accessed gender-affirming care over the objections of her parents. Conservatives want to outlaw that, too.
by Evan Urquhart
A story from New Jersey, in which an adult trans woman legally accessed treatment for gender dysphoria on an informed consent basis, is the latest sign that the Republican attacks on trans people’s access healthcare won’t stop at banning this care for gender dysphoric youth. Using a slanted narrative mixed with falsehoods about the effects of treatment, a story in the Washington Free Beacon by Aaron Sibarium portrayed the act of a trans adult seeking hormone treatments her parents disapproved of as a medical scandal, despite presenting no evidence the young woman was harmed in any way. The National Review quickly picked up the story as well. Both sought to downplay the fact that the trans woman at the center of the story is a legal adult, with the Free Beacon going so far as to describe the 18-year-old as a “special needs kid.”
screenshot from the Washington Free Beacon
The Free Beacon tells the story of an 18-year-old autistic trans woman who came out to her parents at the age of 17. Her parents were skeptical, and believed she would be best served by spending a year on a waiting list for the only clinic in the country that specializes in treating autistic people with gender dysphoria. The trans woman disagreed, and eventually sought treatment at Planned Parenthood while her parents were out of town. The story also includes details that make the trans woman sound masculine, mentioning hobbies of hers which are more stereotypically associated with boys or men. However, gender identity is not based on stereotyped interests, despite repeated false claims by anti-trans activists that trans people base their identities on such stereotypes.
The parents, who do not seem to have any legal authority over their adult daughter’s medical decisions, nevertheless filed a complaint with the New Jersey medical board. The complaint does not seem to indicate anything was done that goes against the standards of care for gender dysphoria, which allow for treatment on an informed consent basis for adults. It also alleges, falsely, that the cross-sex hormones provided to their daughter were in some way irreversible, which is… a stretch. (Taken over an extended period, estrogen can cause noticeable breast growth, and this can only be fully reversed by surgery, but it would not normally interfere with a person returning to live as a man, if desired, because there are a wide range of naturally occurring differences in cis male chests.)
The effects of the treatment on the trans woman in question, whether she is satisfied with the treatment or feels her gender dysphoria has improved, go unaddressed by the Free Beacon. Sibarium seems not to have spoken with the central figure in the story directly. Instead, her parents are quoted liberally, as are experts who advocate against the informed consent model of care.
The Free Beacon’s slimy, misleading approach to reporting this story doesn’t stop with portraying an 18-year-old adult as a “kid.” Although Sibarium attempts to present Planned Parenthood as a new entrant into this arena of healthcare, this is far from the case. While not all Planned Parenthood clinics offer these treatments, some affiliates have offered hormone therapy to trans adults for 8 years or more. While Planned Parenthood clinics also offer referrals to therapists for patients who desire mental health treatment, they do not require an assessment by a therapist to start care. Instead, they use an informed consent model, meaning that an adult patient who has been fully informed about the effects as well as the risks and side effects of treatment with cross-sex hormones is allowed to decide whether they want to proceed. This model is similar to how many patients access birth control or abortion at Planned Parenthood, where the deciding factor in treatment is what the patient believes to be the best match their needs.
The informed consent model in the field of gender-affirming care for adults is not without its critics. However, medical research suggests that patient outcomes are actually better under the informed consent model than they are when medical professionals conduct a more thorough assessment and are empowered to make the final decision about whether treatment is warranted or not. Studies comparing the two approaches have found that there do not seem to be significantly higher rates of regret using an informed consent model in adults, and that the harms and expenses associated with delayed treatment actually result in poorer outcomes for patients whose treatment proceeds in that way.
All that being said, Planned Parenthood’s provision of gender-affirming care is quite bare bones. Many patients would love the chance for a longer, more thorough and individualized conversation with a doctor specializing in this area before starting hormones. Many patients would prefer to spend time speaking with a therapist before commencing treatment as well. The U. S. healthcare system is not currently set up to provide that level of care to all or even most patients, and the stripped-down Planned Parenthood option is significantly better than nothing for patients who have no other options, or for those whose access to a wider array of services comes at the cost of lengthy, harmful wait times.
In medicine, normally the question of what treatment model is best would be decided by what model the research finds produces the best outcome for patients, but of course gender-affirming care is highly politicized; nothing is ever normal here.
Even so, most Americans instinctively recoil at the idea that the government would get involved in limiting the personal, private choices of adults. That’s may be why the Free Beacon felt it necessary to include false information about the impacts of hormone therapy outright.
screenshot from the Washington Free Beacon
Receiving cross-sex hormones as an adult does not result in a permanent loss of fertility. The only treatments that are known to result in the permanent loss of fertility are surgeries to remove the ovaries or testes, which Planned Parenthood doesn’t provide, and which the trans woman at the heart of this story is not claimed to have sought. For an adult in this situation, hormone therapy doesn’t even reliably function as birth control, a prominent warning during any the informed consent process. The only patients believed to have a high risk of permanent loss of fertility are male-assigned youth who access puberty blockers at the earliest stages of adolescence and move from the blockers directly to cross-sex hormones afterwards. For all other patients, stopping hormone therapy restores their fertility, though it is not 100 percent known whether it restores it fully or if there is some diminishment of fertility relative to cisgender peers.
The attacks on adult health care represent a new front in the ongoing attack against trans people’s basic rights, but one that has long been expected. Anti-trans activist groups have long been known to have privately stated their ultimate goal was to stop all medical transition, at every age, and that children were a target of convenience, not principle. Attempting to muddy the waters by portraying legal adults as too young to make medical decisions was a predictable step in the escalation of the attacks on the trans community, and the attempts to remove the right to seek out the only evidence-based treatment for gender dysphoria known to exist.